Original article
Adult cardiac
Is an Age of 80 Years or Greater an Important Predictor of Short-Term Outcomes of Isolated Aortic Valve Replacement in Veterans?

https://doi.org/10.1016/j.athoracsur.2010.04.066Get rights and content

Background

There is a popular perception that aortic valve replacement (AVR) in octogenarians carries a high risk related primarily to advanced age.

Methods

Using the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program, we identified patients who underwent AVR between 1991 and 2007. A prediction model was constructed using stepwise logistic regression methodology for outcome comparisons.

Results

Compared with younger patients (age < 80 years; n = 6,638), older patients (age ≥ 80; n = 504) had a higher prevalence of baseline comorbidities. In a comparison of patients propensity-matched by risk profile (459 from each group), the older group had a higher morbidity rate (21.1% vs 15.5%; p < 0.03) but a similar mortality rate (5.2% vs 3.3%; p = 0.19) compared with the younger group.

Conclusions

After risk adjustment, age of 80 years or greater was independently associated with higher AVR-related morbidity but not mortality. Further work is needed to identify ways to reduce operative morbidity in the extremely elderly.

Section snippets

Patient Population

The Veterans Affairs (VA) Continuous Improvement in Cardiac Surgery Program (CICSP) is part of the VA Surgical Quality Improvement Program and prospectively collects risk and outcomes data on all patients who undergo cardiac surgery at any of 44 VA cardiac surgery centers [17, 18, 19]. After obtaining Institutional Review Board approval and waiver of informed consent, we requested and received approval for the study from the Department of Veterans Affairs Surgical Quality Use Data Group. We

Entire Cohort: Risk Profile

Of all the patients who underwent isolated AVR during the study period, 7% (504 of 7,142) were 80 or greater years old. The vast majority of patients in both age groups were male (Table 1). Compared with the younger patients, the older patients had a higher prevalence of peripheral vascular disease (20% vs 14%), cerebrovascular disease (18% vs 14%), New York Heart Association class III/IV (55% vs 49%), prior myocardial infarction (22% vs 17%), and plasma creatinine 1.5 mg/dL or greater (21% vs

Comment

With advancement in medical sciences and better management of cardiovascular disease and comorbidities, the projected life expectancy of elderly patients continues to rise [20]. This has generated an expanding population of geriatric patients who present with “surgical cardiac disease” requiring operative intervention. Technical advancements in cardiac surgery, better myocardial protection strategies, and improved perioperative care have enabled safe accomplishment of valve replacements in

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The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs or the United States Government.

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